Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) Tanzania - Basic Health Services Project (P125740) AFRICA | Tanzania | Health, Nutrition & Population Global Practice | IBRD/IDA | Sector Investment and Maintenance Loan | FY 2012 | Seq No: 10 | ARCHIVED on 28-Oct-2016 | ISR25517 | Implementing Agencies: Ministry of Health and Social Welfare, Project Coordinator, Regional Administration and Local Government Key Dates Key Project Dates Bank Approval Date:20-Dec-2011 Effectiveness Date:01-Mar-2012 Planned Mid Term Review Date:30-Sep-2014 Actual Mid-Term Review Date:30-Sep-2014 Original Closing Date:30-Jun-2015 Revised Closing Date:30-Oct-2016 Project Development Objectives Project Development Objective (from Project Appraisal Document) The PDO for this project is to assist the Government of the United Republic of Tanzania in improving the equity of geographic access and use of basic health services across districts and enhancing the quality of health services being delivered. This would be achieved by introducing innovative financing mechanisms for health service delivery which encourage both effective and efficient management of health services at the local level and a focus on quality improvement, and would be accomplished within the framework of theHealth Sector Strategic Plan III. Has the Project Development Objective been changed since Board Approval of the Project Objective? No PHRPDODEL Components Name Component 1 - Support for Local Government Service Delivery:(Cost $80.00 M) Component 2 - Capacity Building for Local Governments:(Cost $11.00 M) Component 3 - Central Programs to Support Service Delivery:(Cost $9.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Unsatisfactory  Moderately Unsatisfactory Overall Implementation Progress (IP)  Moderately Unsatisfactory  Moderately Satisfactory Overall Risk Rating  Moderate  Moderate 10/28/2016 Page 1 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) Implementation Status and Key Decisions The Basic Health Services Project (BHSP) aims to improve the equity of geographic access and use of basic health services across districts and enhance the quality of services delivered. This is a third generation health sector reform project whose aim is to bring all development partners and financing under one umbrella to support one health sector program. The project has provided a total financing support of US$100million to support the implementation of the Government of Tanzania’s Health Sector Strategic Plan (III) over the course of 3.5 years. Project proceeds primarily support the Health Basket Fund (85% of total proceeds) and represent a quarter of total HBF resources. The remaining funds are for capacity building and institutional strengthening of the central and local ministry level in improving services delivery. The project is fully disbursed and all activities are now concluded. The achievement of the project’s development objective of delivering equitable quality services was mixed. While access to health services increased under the project, further efforts are needed to improve quality with due attention to geographic equity considerations. The new health project, “Strengthening PHC for Results” is up and running and has taken into account the lessons learned from this project by ensuring that the incentives for improving services are directly linked with the financing of the activity. 10/28/2016 Page 2 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  --  Substantial  Substantial Macroeconomic  --  Substantial  Substantial Sector Strategies and Policies  --  Moderate  Moderate Technical Design of Project or Program  --  Substantial  Substantial Institutional Capacity for Implementation and Sustainability  --  Moderate  Moderate Fiduciary  --  Moderate  Moderate Environment and Social  --  Moderate  Moderate Stakeholders  --  Low  Low Other  --  --  -- Overall  --  Moderate  Moderate Results Project Development Objective Indicators PHINDPDOTBL  Births attended in health facility broken down by LGA (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 58.40 65.90 65.90 69.00 Date 31-Dec-2010 31-May-2016 15-Sep-2016 30-Apr-2016 Comments 71% achieved (7.5% point increase out of a targeted 10.6% point increase) PHINDPDOTBL  Average outpatient attendances per clinical staff broken down by LGA (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1395.00 2413.00 2259.00 1600.00 10/28/2016 Page 3 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) Date 31-Dec-2010 23-Feb-2016 15-Sep-2016 30-Apr-2016 Comments 421% achieved (864 decrease out of a targeted 205 decrease) PHINDPDOTBL  Average outpatient attendances per capita broken down by LGA (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.83 0.70 0.70 1.00 Date 31-Dec-2010 31-May-2016 15-Sep-2016 30-Apr-2016 Comments -76% achieved (0.13 decrease out of a targeted 0.17 increase) PHINDPDOTBL  Health facilities with any stockouts of tracer medicines and vaccines according to CCHP (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 28.00 5.30 5.28 5.00 Date 31-Aug-2011 31-May-2016 15-Sep-2016 30-Apr-2016 Comments 99% achieved (22.7% point decrease as opposed to a targeted 23% point decrease) PHINDPDOTBL  Ratio of the 10 best performing LGAs to the 10 worst performing LGAs in indicators 1 through 3 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value (1)8.1; (2)2:1; (3)17:4 (1) 5.32)15.4 3)11.5 (1) 5.32)15.4 3)11.5 15% decrease Date 31-Dec-2010 23-Feb-2016 15-Sep-2016 30-Apr-2016 Comments IOI#5.1: Ratio of 10 best to 10 worst LGAs for Births Attended: 230% achieved (2.8% point decrease out of targeted 1.2% point decrease). IOI#5.2 and IOI#5.3: These two indicators are ratios of ratios which is not only hard to measure but also hard to interpret, rendering the indicator of limited utility from an M&E perspective. 10/28/2016 Page 4 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) PHINDPDOTBL  Ratio of the 10 best performing LGA’s to the 10 worst performing LGAs in IND1 (Births attended) (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 8.1 8.4 8.4 6.9 Date 31-Dec-2010 31-Dec-2015 15-Sep-2016 30-Apr-2016 PHINDPDOTBL  Ratio of the 10 best performing LGA’s to the 10 worst performing LGAs in IND2 (OP per clinician) (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 2:1 1:6 1:6 1:8 Date 31-Dec-2010 31-Dec-2015 15-Sep-2016 30-Apr-2016 PHINDPDOTBL  Ratio of the 10 best performing LGA’s to the 10 worst performing LGAs in IND3 (Per capita outpatient) (Text, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 17:4 8.1 8.1 12:8 Date 31-Dec-2010 31-Dec-2015 15-Sep-2016 30-Apr-2016 Overall Comments Intermediate Results Indicators 10/28/2016 Page 5 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) PHINDIRITBL  Children immunized (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8015440.00 8016240.00 6142347.00 Date 20-Dec-2011 23-Feb-2016 15-Sep-2016 30-Apr-2016 Comments 131% achieved (8.0m increase out of targeted 6.1m increase) PHINDIRITBL  Children receiving a dose of Vitamin A (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4595139.00 29730482.00 28978389.00 Date 31-Dec-2010 23-Feb-2016 15-Sep-2016 30-Apr-2016 Comments 103% achieved (29.7m increase out of a targeted 28.9m increase) PHINDIRITBL  Direct project beneficiaries (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 36612263.00 48605919.00 37118980.00 Date 31-Dec-2010 31-Dec-2014 15-Sep-2016 30-Apr-2016 Comments 131% achieved (48.6m increase out of a targeted 37.1m increase) 10/28/2016 Page 6 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) PHINDIRITBL  Female beneficiaries (Percentage, Core Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 51.40 51.40 50.50 PHINDIRITBL  Pregnant women receiving antenatal care during a visit to a health provider (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9250455.00 9250455.00 6471889.00 Date 20-Dec-2011 31-Dec-2015 31-Dec-2015 30-Apr-2016 Comments 143% achieved (9.2m increase out of a targeted 6.5m increase) PHINDIRITBL  Health centers in each LGA that provide emergency obstetrical care (EMOC) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 46.00 48.00 45.00 Date 30-Sep-2011 23-Feb-2016 15-Sep-2016 30-Apr-2016 Comments 107% achieved (46% point increase of a targeted 45% point increase) PHINDIRITBL  District Readiness for Service Delivery (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 42.00 65.00 Date 30-Sep-2011 31-Dec-2014 31-Dec-2014 31-Dec-2015 Comments 65%achieved (42% point increase a targeted 65% point increase) 10/28/2016 Page 7 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) PHINDIRITBL Use of performance and equity indicators in LGA allocations and use of the approach developed under this project for service delivery grants in other sectors (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 0.00 Date 20-Dec-2011 31-Dec-2014 31-Dec-2014 30-Apr-2016 PHINDIRITBL  LGAs with unqualified audit reports (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 32.00 77.60 86.00 48.00 Date 30-Jun-2010 23-Feb-2016 23-Feb-2016 30-Apr-2016 Comments 338% achieved (54% point increase out of a targeted 16% point increase PHINDIRITBL  LGAs which have implemented the new DMIS system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 20-Dec-2011 31-Dec-2015 31-Dec-2015 30-Apr-2016 Comments 143% achieved (100% point increase out of a targeted 70% point increase 10/28/2016 Page 8 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) PHINDIRITBL  Council Health Services Boards (CHSB) that meet on a quarterly basis (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 60.00 64.00 85.00 86.00 Date 31-Dec-2010 31-Dec-2015 31-Dec-2015 30-Apr-2016 Comments 96% achieved (25% point increase out of a targeted 26% point increase) PHINDIRITBL  LGAs which have implemented one or more community or social accountability mechanisms (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 667.00 667.00 15.00 Date 20-Dec-2011 23-Feb-2016 23-Feb-2016 30-Apr-2016 PHINDIRITBL  Health personnel receiving training (number) (Number, Core) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 32945.00 32945.00 25500.00 Date 20-Dec-2011 31-Dec-2014 31-Dec-2014 31-Dec-2015 Comments 129% achieved (33k increase out of a targeted 26k increase) PHINDIRITBL  Regional Health Management Teams that have implemented performance monitoring and verification initiatives (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 35.00 Date 20-Dec-2011 31-Dec-2014 31-Dec-2014 31-Dec-2015 10/28/2016 Page 9 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) Overall Comments Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P125740 IDA-50290 Effective XDR 63.10 63.10 0.00 63.10 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P125740 IDA-50290 Effective 20-Dec-2011 17-Jan-2012 01-Mar-2012 30-Jun-2015 30-Oct-2016 Cumulative Disbursements Restructuring History Level 2 Approved on 21-May-2015 ,Level 2 Approved on 29-Apr-2016 10/28/2016 Page 10 of 11 Public Disclosure Copy Public Disclosure Copy The World Bank Implementation Status & Results Report Tanzania - Basic Health Services Project (P125740) Related Project(s) There are no related projects. 10/28/2016 Page 11 of 11 Public Disclosure Copy